Trauma, stress, and multiple sclerosis.

The possible relationship between physical trauma or psychologic stress and a symptom of nervous system dysfunction that appears or recurs has long puzzled neurologists, psychiatrists and lawyers. Expert opinions have varied from the definite implication of such relationship to the view that neither trauma nor stress causes or even precipitates disease symptoms. In studying this question, it is important to make the distinction between an etiologic factor and a precipitating one. Prolonged exposure to cold and the resultant chill may be followed by pneumonia, but the causal factor is the pneumococcus; sexual intercourse does not lead to syphilis unless the spirochete is introduced into the system. How emotional factors produce an alteration of normal physiologic mechanisms in a psychosomatic illness such as peptic ulcer disease is unknown. This is also true in multiple sclerosis, where the causal factor is unknown as well. There is a vast difference between considering an event as some kind of causal factor, or trigger for a pathogenetic mechanism, and considering it a precipitating factor, which brings about a physiologic alteration leading to the appearance of the signs and symptoms of a pre-existing lesion of the nervous system. A specific event, whether it is an accident, a surgical operation, the death or serious illness of a loved one, or an important decision affecting a career or a marriage, represents severe stress in a person's life. Such an event may precipitate an attack of multiple sclerosis (MS). It could call attention to an already existing but previously overlooked symptom. There is some degree of secondary gain, emotional, financial or social, possible for any of us at such a time. A better understanding of the pathogenic and pathophysiologic mechanisms in cases of MS will help clarify this question.